Table 2.
Advantages and disadvantages of the main methods of nutritional assessment for cirrhotic patients with hepatic encephalopathy
| Method | Advantages | Disadvantages |
| SGA | Quick application | Requires patient comprehension and collaboration |
| Low cost | Subjectivity (the only objective measure used is weight) | |
| Can identify patients under risk of malnutrition | Can underestimate malnutrition | |
| upon hospital arrival | Cannot be used as a follow-up method | |
| Can be applied in hospital rooms | ||
| Anthropometry | Quick application | Some measures (body weight, body mass index, AC, TSF) can be highly influenced by water retention and overweight/obesity |
| Low cost | Interobserver variation decreases the data reproducibility | |
| Demands little collaboration | Can underestimate malnutrition | |
| Can be applied in hospital rooms | ||
| Some measures (CAMA, MAMC, APMT) are less influenced by water retention and overweight/obesity | ||
| MAMC is widely recommended for liver disease patients | ||
| MAMC and TSF are associated with outcomes in cirrhotic patients and are related to the presence of HE | ||
| Handgrip strength | Quick application | Cannot identify muscle wasting anatomically |
| Low cost | Is not so suitable for evaluating cirrhotic women, because skeletal | |
| Can be applied in hospital rooms | muscle function correlates with muscle mass only in men | |
| Identify impaired muscle function | ||
| Is not influenced by either water retention or overweight/obesity | ||
| Is an independent predictor of cirrhosis decompensation | ||
| Bioelectrical impedance analysis | Quick application | Controversial applicability in patients with fluid retention |
| Can be applied in hospital rooms when portable equipment is used | Requires patient removal to the equipment room when non-portable equipment is used | |
| PA and BCM are associated with outcomes in cirrhotic patients | Can underestimate malnutrition | |
| Dual-energy X-ray absorptiometry | Adequate accuracy to identify muscle depletion | High cost |
| Excellent reproducibility | Requires patient removal to the equipment room | |
| Can also identify bone mass reduction as a screening tool | Exposure to ionizing radiation makes routine use less attractive as a follow up method | |
| Gives detailed analyses of body composition (segmental results), obtaining measures that have prognostic impact in cirrhotic patients | ||
| FFMI is an independent predictor of HE | ||
| AMMI can be used to diagnose sarcopenia | ||
| Computed tomography scan | Adequate accuracy to identify muscle depletion | High cost |
| Excellent reproducibility | Requires patient removal to the equipment room | |
| Can be performed retrospectively from images previously obtained | Exposure to ionizing radiation makes routine use less attractive as a follow-up method | |
| Can also identify hepatic nodules, portosystemic shunts and other abnormalities | ||
| Skeletal muscle thickness in cross-sectional images has prognostic impact in cirrhotic patients | ||
| L3 SMI can be used to diagnose sarcopenia |
The bedside techniques are presented at the top and can be valuable even in conditions of restricted access to technology. The more complex methods are shown at the bottom, and should also be used when technology is unrestrained, providing more accuracy. Methods used only for research purposes and those not applied to patients with hepatic encephalopathy are not included. AC: Arm circumference; AMMI: Appendicular muscle mass index; APMT: Adductor pollicis muscle thickness; BCM: Body cell mass; CAMA: Corrected arm muscle area; FFMI: Fat-free mass index; HE: Hepatic encephalopathy; L3 SMI: Third lumbar vertebrae skeletal muscle index; MAMC: Mid-arm muscle circumference; PA: Phase angle; TSF: Triceps skinfold; SGA: Subjective Global Assessment.